Diandra Bankhead, the owner and operator of Elite Homecare (“Elite”), an Atlanta-based home healthcare provider, has been sentenced for five years and three months in federal prison for defrauding Medicaid out of nearly $1 million. Between September 2015 and April 2018, Bankhead submitted thousands of fraudulent claims for services that were never provided to medically fragile children under the Georgia Pediatric Program (“GAPP”).

Upon leaving prison, Bankhead will have three years of supervised release, and ordered to pay $999,999, in restitution.

“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung J. “BJay” Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”

According to a press release, Elite Homecare submitted more than 5,400 claims to Georgia Medicaid—the vast majority of which were fraudulent—and for which Elite received $1.2 million in reimbursement. Bankhead defrauded Medicaid in a number of ways, including:

  • Submitting fraudulent credentialing information to the State of Georgia Department of Community Health in order to become a certified GAPP provider, including falsely representing that a registered nurse (“RN”) —without her knowledge or authorization—served as Elite’s RN Supervisor.
  • Falsely representing to Medicaid that an RN or RN Supervisor had conducted the initial evaluation of putative GAPP members as required by applicable regulations.
  • Submitting fraudulent claims for in-home nursing services allegedly provided to families who had not retained Elite to provide any services.
  • Submitting fraudulent claims in which Elite employees allegedly provided more than 24 hours of services in a given day.
  • Submitting fraudulent claims where Elite employees were impossibly providing services to multiple children simultaneously.
  • Submitting fraudulent claims in the names of multiple individuals, including RNs, who did not provide the services in question, and did know that their identities and credentials were being used.
  • Submitting fraudulent claims that had been “upcoded” – that is claims which fraudulently increased the amount Medicaid paid Elite – by materially misrepresenting the level of care provided and the level of licensing for the individual allegedly providing the services. For example, Elite submitted fraudulent claims to Medicaid purporting that an RN (billed at $40/hour) had rendered the services when in fact a licensed professional nurse (billed at $30/hour) and/or personal care service provider (billed at $20/hour) had actually done so.
  • Preparing fraudulent supporting documentation for the in-home nursing services that were never provided, including fraudulent patient care charts.

“Bankhead’s lack of concern for the needs of fragile children to profit rather than care for them is very troubling, and now she must pay the price for her greed,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “Not only did she deny care to children in need, but she also stole taxpayer dollars from a Medicaid program that should have gone to those who need them.”

In addition to the underlying fraud, Bankhead also failed to truthfully disclose her finances to the United States Probation Office as required by her plea agreement. Rather, the information presented at sentencing established that Bankhead entered into a kickback arrangement with another Atlanta-based home health provider under which she “sold” twenty of Elite’s former clients in exchange for receiving a percentage of the Medicaid billings tied to those clients going forward.

Photo: Shutterstock

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